An Expert Review of Clinical Trial Updates for CLL

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Topics include: Treatments

At the 2018 American Society of Hematology (ASH) annual meeting, Dr. Susan M. O'Brien, from the University of California Irvine Medical Center, joined Patient Power to share exciting results from chronic lymphocytic leukemia (CLL) clinical trials with combination therapies. Dr. O’Brien discusses remission duration found in the study and compares the patient outcomes to commonly used frontline regimens. Is there still a role for chemotherapy in CLL care? Tune in to find out the latest treatment research.

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Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

So, Dr. O’Brien, let’s talk about another study, ibrutinib (Imbruvica) instead of bendamustine-rituximab (Treanda-Rituxan). 

It was used in a couple of different ways. So, tell us about that and what’s significant about that.

Dr. O’Brien:                

So, there was a very big trial that was presented at the plenary session. And the plenary sessions are generally regarded as some of the most important talks. So, you can see how this trial was assessed. And it was a randomized trial in patients with CLL, all over the age of 65 who were needing treatment but were randomly assigned to either bendamustine-rituximab, very commonly used chemotherapy regimen in the US, probably the most commonly used one in CLL, or ibrutinib, or there was a third arm combining ibrutinib with rituximab. We know that rituximab always makes chemotherapy better. 

And so, this was asking the same question, when we move out of chemo but into small molecules, will that continue to hold true. And the randomized trial showed that ibrutinib or ibrutinib-rituximab were both better than BR, in terms of progression free survival.

And, basically, what that means is the durability of the remissions that these people achieved. So, the remissions were lasting longer with ibrutinib based therapy than they were with BR. The other important point, however, is that the Ibrutinib and rituximab and ibrutinib looked exactly the same so far. So, no difference. So, a little bit different than the picture and chemo where adding the antibody always improves the outcome. That doesn’t appear to be the case with ibrutinib. But here, the most important question really was the comparison of BR to Ibrutinib, since BR is such a commonly used frontline regimen.

Andrew Schorr:          

Okay. So, with BR though, people are able to stop, after so many cycles.

Dr. O’Brien:                

That’s right.

Andrew Schorr:          

And with ibrutinib, it would assume, versus the ibrutinib-venetoclax (Imbruvica-Venclexta), you continue, right? 

Dr. O’Brien:                

Right. 

Andrew Schorr:          

And so, in this age of financial toxicity where we worry about the cost of therapy, too. So, it’s great if you don’t have to use the rituximab. 

 So, that saves the money from that drug. But you’d still stay on therapy.

Dr. O’Brien:                

That’s exactly right. And so, one of the advantages for patients is that, for financial reasons, they may actually prefer the chemotherapy. There’s no difference in survival in that trial so far, although there’s very few events, meaning most people are still alive. So, there’s no difference in survival. So, even if the remissions last longer with ibrutinib, you could argue that if you gave the BR first and got a few years out of it, and then, you gave ibrutinib, you’d still have very long remissions. We know it works great in patients after chemo. So, I think it still leaves the door open for the role of chemotherapy there.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on September 9, 2019